Does ingrezza still cost $72000 a year?

[the5thelement]

Seems like a lot of money for one of the few meds FDA approved for tardive dyskinesia.
Who ends up footing the bill?

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[deleted1100659]

Not sure but I have many people on it, they have a fairly good patient support program

 

[Old&InTheWay]

Medicaid covers it in my state.

 

[Jules A]

A patient of mine is getting Austedo with private insurance after PA for the initial and each dose increase.

 

[Celexa]

Are you all finding it more effective than the myriad other potentially indicated medications for TD? I don't treat a population with high TD prevalence so little experience with most meds for it in general.

What other potentially indicated meds? There's nothing else with what I would call robust evidence.

I've offered the VMAT2 inhibitors to several patients, been surprised that most of them didnt actually want to try it. Probably reflective of the mainly Medicaid population in some of our clinics that even severe TD doesn't cause them much functional difficulty. Have one high functioning patient in a white collar job I put on it, the response was excellent at the starter dose. Patient is thrilled. I am thrilled I don't have to make adjustments to a regimen that finally achieved stability. Prior Auth was easy to get with appropriate AIMS documentation.

Studies on them seem good. Despite their cost I plan to use them as first line treatment for TD if removing/decreasing the offending agent is not an option, or if it persists despite dose adjustment.

 

[Username2015]

When I looked at the studies a few years ago, the AIMS score improvement seemed unimpressive, especially for the high financial cost of the drugs. Haven’t read newer studies, though.

 

[the5thelement]

According to Maudsely, these are the recommendations on how to deal with TD.
1.Stop anticholinergic if prescribed
2.Reduce dose of antipsychotic
medication
3.Change to an antipsychotic with lower
propensity for TD 24–27 (note that data
are conflicting 28,29 )
3.Clozapine is the antipsychotic most
likely to be associated with resolution
of symptoms. 30 Quetiapine may also be
useful in this regard 31
4.Both valbenazine and deutetrabenazine
have a positive risk–benefit balance as
add-on treatments 32–35
5There is also some evidence for
tetrabenazine and Ginkgo biloba3 6 as
add-on treatments.

 

[NickNaylor]

Went to a pharmacy dinner for Ingrezza once - mostly because I wanted to go to the restaurant the dinner was hosted at - and the initial approval studies should a very unimpressive response. Yes, improvement in AIMS was statistically significant, but the magnitude was negligible. Even on the package insert, the clinical data is... lacking - the mean change in AIMS score is about -2 and about -3 for the 80 mg dose. Of course, at the dinner I attended the presenter showed these amazing pre/post videos of supposed patients where the AIMS seemed to go from 28 to 0.

Whatever the cost is now, anything about about tree fiddy is too much IMO.

 

[Celexa]

Went to a pharmacy dinner for Ingrezza once - mostly because I wanted to go to the restaurant the dinner was hosted at - and the initial approval studies should a very unimpressive response. Yes, improvement in AIMS was statistically significant, but the magnitude was negligible. Even on the package insert, the clinical data is... lacking - the mean change in AIMS score is about -2 and about -3 for the 80 mg dose. Of course, at the dinner I attended the presenter showed these amazing pre/post videos of supposed patients where the AIMS seemed to go from 28 to 0.

Whatever the cost is now, anything about about tree fiddy is too much IMO.

Sure, the aggregate difference isn't huge. But it includes plenty of people with meaningful individual change. The raters in the studies were rigorously blinded which is the most important thing.

The other aspect being it doesn't take long to know if it's working. So--can try it, assess at next visit, maybe make a dose adjustment or two. If there's a meaningful difference, horray, continue! If not, OK we tried but no point in continuing.

Sure, it's more expensive than it should be in a fair world. Many things are. But if it works for a patient I'm happy to prescribe it. New med for a real problem that didn't have any good treatments and which can have a major impact on quality of life. I'm as skeptical of big pharma as anyone but sometimes they do produce something useful. Ingrezza and Austedo are certainly no Aduhelm.

 

[Duloxetini]

The observer reports for much/very improved (likert scale top 2 categories) were pretty staggering for both ingrezza and austedo. Patient reported outcomes weren't as compelling, but as a geripsych attending pointed out during my talk*, TD generally is more distressing to family member than to the patients.

*talk on VMAT-2 inhibitors for TD as part of our residency curriculum

Also the MCID for AIMS is like 2 points (iirc), but I believe this was calculated from one of the trials (valbenazine KINECT trial)

Abnormal involuntary movement scale in tardive dyskinesia: Minimal clinically important difference

A minimal clinically important difference has not been established for the Abnormal Involuntary Movement Scale in patients with tardive dyskinesia. Valbenazine is a vesicular monoamine transporter 2 inhibitor approved for the treatment of tardive dyskinesia ...

www.ncbi.nlm.nih.gov

 

[deleted1100659]

Ive been meaning to reply and just wanted to mention a few points.

Im very familiar with ingrezza/austedo, have several patients on them. Most of them improve (i mainly use ingrezza) in terms of TD. Ive actually seen it work wonders in some patients.

They also have great patient support programs. If you can get your patient on it, its worth a shot. Even if its just a few point reduction on AIMs, for the patient that can have a huge impact. I would say most of the people I put on it, generally like it.

Thats just my own personal experience, and I work in a community healthcare setting with higher acuity patients with significant exposure to antipsychotics.